光棒引导经鼻插管在张口困难患者中临床应用

目的:探讨光棒引导经鼻气管插管在张口困难患者中应用的可行性.方法:选择82例口腔颌面外科张口困难(张口度＜2.5 cm)患者,在快诱导麻醉下由光棒引导经鼻气管插管.记录患者麻醉诱导前后、插管过程中和插管后的SBP、DBP和HR.记录插管成功时的插管次数、插管时间及术后24 h并发症发生率.结果:82例患者中,53例(64.6％)一次性插管成功,29例(35.4％)经2～3次插管成功.插管操作时间(75.4-±26.4)s.与诱导前相比,插管时的BP和HR差异无显著性.术后随访2例有轻微咽部不适,1例主诉咽喉疼痛.结论:光棒引导经鼻气管插管对血流动力学影响轻微,口咽部损伤小,成功率高,在张口困难患者中值得推广应用.     

A prospective randomized trial of transnasal ileus tube vs nasogastric tube for adhesive small bowel obstruction

AIM:To study the therapeutic efficacy of a new transnasal ileus tube advanced endoscopically for adhesive small bowel obstruction.METHODS:A total of 186 patients with adhesive small bowel obstruction treated from September 2007 to February 2011 were enrolled into this prospective randomized controlled study.The endoscopically advanced new ileus tube was used for gastrointestinal decompression in 96 patients and ordinary nasogastric tube(NGT) was used in 90 patients.The therapeutic efficacy was compared between the two groups.RESULTS:Compared with the NGT group,the ileus tube group experienced significantly shorter time for relief of clinical symptoms and improvement in the findings of abdominal radiograph(4.1 ± 2.3 d vs 8.5 ± 5.0 d) and laboratory tests(P 0.01).The overall effectiveness rate was up to 89.6% in the ileus tube group and 46.7% in the NGT group(P 0.01).And 10.4% of the patients in the ileus tube group and 53.3% of the NGT group underwent surgery.For recurrent adhesive bowel obstruction,ileus tube was also significantly more effective than NGT(95.8% vs 31.6%).In the ileus tube group,the drainage output on the first day and the length of hospital stay were significantly different depending on the treatment success or failure(P 0.05).The abdominal radiographic improvement was correlated with whether or not the patient underwent surgery.CONCLUSION:Ileus tube can be used for adhesive small bowel obstruction.Endoscopic placement of the ileus tube is convenient and worthy to be promoted despite the potential risks.     

鼻内镜辅助RS泪道插管术治疗儿童先天性鼻泪管阻塞

目的:探讨鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞的有效性和安全性,指导临床应用。方法:回顾性系列病例研究。选取2016-09/2019-09在我院就诊的泪道探通无效的先天性鼻泪管阻塞患儿158例158眼作为研究对象,患儿均行鼻内镜辅助RS泪道插管术治疗。术后1、3、6mo定期随访。观察患儿性别、年龄、既往泪道探通次数、术前泪道有无分泌物、治疗效果、并发症、鼻泪管阻塞类型。对年龄、探通次数与手术有效率之间的关系做Spearman秩相关系数计算与分析,对不同类型鼻泪管阻塞的手术有效率采用Fisher确切概率法检验,对有无脓性分泌物的手术有效率做χ2检验。结果:总手术有效率为89.9%(142/158)。手术有效率随着年龄增长呈下降的趋势(rs=-1.000,P<0.01)。手术有效率随着泪道探通次数增多呈下降的趋势(rs=-1.000,P<0.01)。膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞(P<0.05)。有无脓性分泌物两种症状的手术有效率无差异(P>0.05)。主要并发症有:假道16眼(10.1%)、泪道引流管提前脱出14眼(8.9%)、眼红、刺激性溢泪18眼(11.4%)、上下泪点对合黏连3眼(1.9%)、泪点肉芽肿1眼(0.6%)。结论:鼻内镜辅助RS泪道插管术治疗泪道探通无效的儿童先天性鼻泪管阻塞有较高有效率,较好的安全性。手术有效率随着年龄增长而下降,随着泪道探通次数增多而下降,膜性鼻泪管阻塞手术有效率高于复杂性鼻泪管阻塞。     

McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的比较

目的 比较McGrath可视喉镜与Macintosh直接喉镜显露颈椎手术患者喉部结构的效果. 方法 50例颈椎手术患者采用随机数字表法随机分为McGrath组和Macintosh组,每组25例.麻醉诱导后,McGrath组先用Macintosh直接喉镜显露喉部结构并记录Cormack-Lehane分级(C/L分级),不插管,再改用McGrath可视喉镜显露喉部结构并插入气管导管.Macintosh组先用McGrath可视喉镜显露声门,再使用Macintosh直接喉镜显露喉部结构并插管.记录患者一般情况、气道评估指标(甲颏间距、张口度、Mallampati分级、颈部活动度)、喉镜显露C/L分级和插管并发症. 结果 两组间患者一般情况和气道评估指标差异无统计学意义(P＞0.05).McGrath可视喉镜的C/L分级(Ⅰ级∶Ⅱ级∶Ⅲ级为34∶14∶2)显著优于Macintosh直接喉镜(Ⅰ级∶Ⅱ级∶Ⅲ级为13∶32∶5,P＜0.01). 结论 McGrath可视喉镜对喉部结构的显露优于Macintosh直接喉镜,提示该可视喉镜有助于颈椎手术患者的气管插管处理.